CASE 004 · Emergency Department · Advanced · 10–14 min
The Patient Whose Words Stopped Working
· Patient arriving
71-year-old female — “Her words came out all wrong at breakfast.”
8:12 AM — her daughter drove her in. The right side of her face isn't moving right, and her answers come out as scrambled fragments.
BP 178/96HR 96 irregRR 18SpO₂ 96% RATemp 98.4°F
You do not get the diagnosis. You get the patient. Reason your way there.
What SHOULD be happening?A — Assess Normal
Carotid and vertebral arteries feed the brain continuouslyLeft MCA perfuses speech areas + right face and armNeurons run on constant oxygen + glucose — no reserveFlow never pauses, so function never pausesWords form, face moves, arm obeys
One artery has gone quiet. The brain keeps almost no fuel in reserve — downstream neurons fail within seconds and start dying within minutes. In this case, the clock IS the disease.
RUN IT · ACTIVEThis patient deteriorates while you work. Time matters.
MaldekChin cases are for healthcare education and clinical-reasoning training. They do not replace local protocols, faculty instruction, clinical supervision, or professional judgment.